CIHR Team in Frailty and Aging  
              
RP#1: The International Database Inquiry on Frailty (FrData)

PRINCIPAL INVESTIGATORS: H Bergman, C Wolfson;

CO-INVESTIGATOR: F Béland;
COLLABORATORS: K Bandeen-Roche, J Brodsky, D Deeg, L Ferrucci, L Fried, J Guralnik, L Gutiérrez-Robledo, D Kuh, S Maggi, A Otero, F Paccaud, M Puts, H Payette, B Santos-Eggimann;
RESEARCH STAFF: N Sourial (Study Coordinator), J Fletcher, B Zhu, S Karunananthan
POST-DOCTORAL FELLOWS: J Quail; D Weiss

OBJECTIVES: Frailty has emerged as an increasingly important concept; however, debate still remains over its characteristics1. The objectives of this study are: 1) to examine the association among 7 candidate frailty domains; and 2) to test the ability of the domains, individually and in combination, to predict adverse outcomes.

METHODS: Seven frailty domains were selected based on a literature review by the Canadian Initiative on Frailty and Aging: nutrition, physical activity, mobility, strength, energy, cognition, and mood. To explore the association among these domains, Multiple Correspondence Analysis (MCA)2, a multivariate graphical technique, was selected. The predictive validity of these domains will be evaluated using appropriate regression models.

Data from 14 existing longitudinal studies of ageing from 8 different countries will be used to ascertain the consistency of the findings: 3 pilot studies – the Montreal Unmet Needs Study (MUNS)3 [C Wolfson], the Canadian Study of Health and Aging4 [C Wolfson] and the System of Integrated Services for Older Persons (French acronym, SIPA)5 [F Beland] and 11 international studies – NuAGE6 [H Payette], the Baltimore Longitudinal Study of Aging7 [L Ferrucci], InCHIANTI8 [L Ferrucci], the Cardiovascular Health Study9 [L Fried], Established Populations for Epidemiologic Studies of the Elderly (EPESE)10 [J Guralnik], the Mexican Health and Aging Study (MHAS) [L Gutiérrez-Robledo], the Longitudinal Aging Study Amsterdam (LASA)11 [D Deeg], the Italian Longitudinal Study of Aging12 [S Maggi], the Lausanne cohort LC 65+ [B Santos-Eggimann], Aging in Leganes13 [A Otero] and the Study on Frailty in Israel [J Brodsky]. The budget will allow us to apply the methods developed in the pilot to 5 of the international databases: NuAge, LASA, EPESE, MHAS and InChianti. Additional sources of funding will be sought in order to apply the methods to the remaining studies.

EXPECTED RESULTS: The results of this study will serve to elucidate the associations among potential frailty domains for which no published research exists. Pilot results suggest that these domains may be measuring a common underlying construct, capable of distinguishing frail from non-frail individuals. Replication of the methodology in several databases will allow us to exploit a large and diverse pool of samples of community-dwelling elderly persons in order to evaluate the robustness of the findings.

TIMELINE: This study will be conducted over a 4-year period. Pilot work for Objective 1 was conducted between January 2005 and March 2006. Selection of measures in the 5 selected international databases is underway and statistical analyses are expected to be completed by February 2009. Methodology for Objective 2 should be finalized by November 2007. Pilot work for Objective 2 will be completed by April 2008. Replication in the international studies combined with a meeting with the international collaborators to discuss the implications of the findings is predicted for April 2011. A final report of the findings will be submitted for publication in September 2011.

INSTITUTIONAL SETTING: Development of the methodology, coordination of the project and statistical analysis will be conducted by the Solidage FrData team, which is housed in the Lady Davis Institute (LDI) for Medical Research at the Jewish General Hospital. Data preparation for the international databases will be conducted by the collaborators in their respective institutions.

REFERENCES
1. Bergman H, Ferrucci L, Guralnik J et al. Frailty, an Emerging Research and Clinical Paradigm: Issues and Controversies. J Gerontol A Biol Sci Med Sci. 2007;62 (7): 731.
2. Benzécri, J.P. (1992) Correspondence Analysis Handbook, New York : Marcel Dekker.
3. Quail JM, Addona V, Wolfson C, Podoba JE, Levesque LY, Dupuis J. Association of unmet need with self-rated health in a community dwelling cohort of disabled seniors 75 years of age and over. European Journal of Ageing. 2007;4(1):45-55.
4. Canadian Study of Health and Aging Working Group. The Canadian Study of Health and Aging: study methods and prevalence of dementia. CMAJ. 1994;150:899-913.
5. Béland F, Bergman H, Lebel P et al. A System of Integrated Care for Older Persons With Disabilities in Canada: Results From a Randomized Controlled Trial. Journal of Gerontology: Medical Sciences. 2006;61A(4):367-373.
6. Payette H, Gaudreau P, Kahlil A, Shatenstein B, Morais J, Gray-Donald K et al. Nutrition as a determinant of successful aging: The Québec Longitudinal Study (NuAge). 18th Congress of the International Association of Gerontology (Rio de Janeiro, June 26-30, 2005). 2005.
7. Shock NW. Normal human aging: the Baltimore longitudinal study of aging. Gerontology Ressearch Center 1984.
8. Ferrucci L, Bandinelli S, Benvenuti E, Di Iorio A, Macchi C, Harris TB et al. Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr.Soc. 2000;48:1618-25.
9. Fried LP, Borhani NO, Enright P, Furberg CD, Gardin JM, Kronmal RA et al. The Cardiovascular Health Study: design and rationale. Ann.Epidemiol. 1991;1:263-76.
10. Cornoni-Huntley J, Ostfeld AM, Taylor JO, Wallace RB, Blazer D, Berkman LF et al. Established populations for epidemiologic studies of the elderly: study design and methodology. Aging (Milano.) 1993;5:27-37.
11. Puts MT, Lips P, Deeg DJ. Sex differences in the risk of frailty for mortality independent of disability and chronic diseases. J Am Geriatr.Soc. 2005;53:40-7.
12. Maggi S, Zucchetto M, Grigoletto F, Baldereschi M, Candelise L, Scarpini E et al. The Italian Longitudinal Study on Aging (ILSA): design and methods. Aging (Milano.) 1994;6:464-73.
13. Zunzunegui MV, Beland F, Otero A. Support from children, living arrangements, self-rated health and depressive symptoms of older people in Spain. Int. J Epidemiol. 2001;30:1090-9.

 

 
 
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Updated February 11, 2013